4. SIdney Farber's early clinical experiments with antifolates in 1947 and 48 were a failure, with all his young leukemia patients eventually dying fo teh the disease. But with the results of these trials, Mukherjee writes, Farber saw a door open. Why do Farber's trials mark a turning point in the history of cancer research?
5. Review the case on Min Chiu Li (135-138) and explain why Freirich said that Li was accused of experimenting on people, but that he also states that everyone was experimenting .. to not experiment would mean to follow the old rules-to do absolutely nothing. Do you think Li's actions were ethical?
5. Review the case on Min Chiu Li (135-138) and explain why Freirich said that Li was accused of experimenting on people, but that he also states that everyone was experimenting .. to not experiment would mean to follow the old rules-to do absolutely nothing. Do you think Li's actions were ethical?
3. The author writes how in the early 1950's, the New York Times refused to print the word cancer or breast. Compare this to how we view cancer today.
ReplyDeleteMukherjee writes how in the early 1950’s, the New York Times refused to print the words cancer or breast. In my opinion this is completely different of how we view cancer today. For the New York Times refusing to print the words cancer or breast was in a way ignoring the fact that cancer (breast cancer in this case) exists. The New York Times was careful in their choosing of words. They wanted to replace cancer with disease and breast with chest wall and all of a sudden breast cancer became a disease of the chest wall. Cancer in the 1950’s was a “politically silent illness” where cancer patients fought their own private battles in the isolated quarters of hospitals. It seems as if though the mere words, breast cancer, were just as haunting as the actual disease. The mentality of cancer back then was something that shall not be named and that bad things could only come if spoken. This view of cancer has changed. Cancer is no longer a politically silent illness; I bet the New York Times has no problem printing the words breast cancer now. Cancer now is a disease that is acknowledged and no longer is a disease that is whispered about and no one speaks of. The view of cancer has changed because there are treatments and cures for some cancers today, cancer has become a disease where more information is desired instead of an overlooked disease.
4. Sidney Farber's early clinical experiments with antifolates in 1947-48 were a failure, with all his young leukemia patients eventually dying from the disease. But with the results of these trials, Mukherjee writes, Farber saw a door open. Why do Farber's trials mark a turning point in the history of cancer research?
Farber’s early clinical experiments with antifolates were both a failure and a success in my opinion. The reason why Farber’s antifolates were a failure was because all of his young leukemia patients eventually died of the disease. However, what the antifolates did do to the leukemia, and this is why I think of the antifolates a success, was that the antifolates hindered the leukemia, at least for a while. This marked a turning point in the history of cancer research. After hearing about what Farber’s antifolates did to leukemia others went on and carried on their own treatments with the antifolates. Farber’s antifolates were a poison that was a drug in disguise. The attitude toward the antifolates was that two were better than one and three better than two and four better than three and so on and so forth. Freirich was among those who approached this idea; VAMP was a four-drug combination therapy for leukemia. When the VAMP trials began the children with leukemia were worse off than before by the end of the week. But by the end of the third week, the children pulled through and the normal bone marrow recovered slowly. The four-drug concoction had cured the children with leukemia but this victory was short-lived; the patients came back with complaints of headaches, the leukemia had colonized the brain. Ignoring the fact that leukemia had colonized the brain, the VAMP treatment was an achievement, an achievement that all began with Farber and his antifolates.
#5 on next comment, did not fit as one comment :)
5. Review the case on Min Chiu Li (135-138) and explain why Freirich said that Li was accused of experimenting on people, but that he also states that everyone was experimenting .. to not experiment would mean to follow the old rules-to do absolutely nothing. Do you think Li's actions were ethical?
ReplyDeleteThe case of Min Chiu Li was one of my favorite sections of the book. Li was working on a rare form of cancer, a cancer present only in women, choriocarcinoma. Choriocarcinoma, a form of cancer that was rarer than leukemia, is a cancer of the placenta that can cause tumorous growths in the lung. Choriocarcinoma “grows out of the placental tissue surrounding an abnormal pregnancy, then metastasizes rapidly and fatally into the lung and the brain.” Choriocarcinoma cells secrete a hormone called choriogonadotropin and the level of this hormone can be used to track the course of the cancer as it responds to a specific type of drug. The drug was methotrexate. Li treated his patients with choriocarcinoma with methotrexate and observed that the choriogonadotropin hormone levels had dropped significantly, to a negligible amount, but not to a complete zero. Li’s reasoning was that the choriogonadotropin levels had not fallen completely to zero because there was a fingerprint of the cancer in the blood and that the cancer was hiding in the body somewhere even though the once visible tumors were gone. In other words Li’s patients had not been fully cured. What Li did next explains why Freirich says that Li was accused of experimenting on people. Li performed additional rounds of the drug along with chemotherapy until the hormone levels fell down to zero. Li was accused of experimenting on people because in the eyes of the NCI the patients were cured once the tumors had vanished and further chemotherapeutic treatments was merciless. The results of “Li’s experiments” were that the cancer never relapsed in his patients but did in others. Freirich also says that Li was not the only one experimenting and that all were experimenting and to not experiment would mean to follow the old rules and do absolutely nothing. Freirich says this because they too were using the same methods that Li was using, chemotherapy along with doses of extremely toxic drugs, the difference was that Li acted on his convictions (recurrent dosage of toxic drugs with chemotherapy until the hormone levels dropped down to zero) and eventually was fired for doing so. To determine whether Li’s actions were ethical or not is hard in my opinion. In this day and age I would say that Li’s actions were unethical; Li did not know what the outcome of the additional rounds of chemotherapy along with drugs would be, he was experimenting on people. Nowadays this is frowned upon because there are various phases a drug treatment has to go through before it can be tested on humans. On the other hand, going back to that time, I would consider Li’s actions ethical only because Li’s time was a time of desperation and desperate times calls for desperate measures. Ethical or unethical Li’s actions, I think we can all agree, were necessary.
3. In 1950 when Fanny Rosenow, a breast cancer survivor and cancer advocate, called the New York Times to post an advertisement for a support group for women with breast cancer, she was told by the editor, " I'm sorry, Ms. Rosenow, but the Times cannot publish the word breast or the word cancer in its pages. Perhaps, you could say there will be a meeting about diseases of the chest wall." Unbelievable, right? Not really. Consider the timing. By the early 1940's military conflicts had broken out all over Asia and Europe, setting the stage for WW2. The war forced America to reconsider its priorities and cancer was not among them. Cancer became the disease that was only 'whispered' about and not spoken of publicly. Today, we find the word cancer attached to other words such as, breast, cervical and pancreatic and they are advertised on T.V. commercials, bus billboards and the internet. Today, regardless of world affairs, we are adamant about advertising cancer - its victims, survivors, drug companies, therapies, research, and support resources. As Farber learned, " For any illness to rise to political prominence, it needed to be marketed, just as a political campaign needed marketing. A disease needed to be transformed politically BEFORE it could be transformed scientifically."
ReplyDelete4. When cells divide they need to make copies of DNA. Folic acid is a crucial building block for DNA and so Folic Acid is crucial for cell division. Farber believed that without folic acid there would be no new blood cells in the bone marrow. But what he found was that injecting patients with folic acid actually increased the patient's Leukemia. So Farber looked for an 'anti-folate' that would block the growth of white blood cells, ultimately stopping Leukemia. In the 6 months between 1947-1948, Farber saw a door open- briefly- then close shut again. Farber used the antifolate 'aminopterin' chemical with a small change from the structure of PAA. He injected the chemical into patients whose white cell count had been climbing astronomically. The result was their white cell count stopped rising and hovered at a plateau, then dropped. Some patients experienced remission for a few months, but the cancer would inevitably relapse and the patients died. Yet the remissions were still genuine remissions and historic. Farber's trials mark a turning point in the history of cancer because he showed the 'disappearance' of an aggressive systemic cancer via a chemical drug. "He dreamed of malignant cells being killed by specific anticancer drugs, and of normal cells regenerating and reclaiming their physiological spaces; of curing leukemia with chemicals." Farber threw down a gauntlet for cancer medicine. It was (is) up to an entire generation of doctors and scientists to pick it up.
ReplyDelete5. Li had heard of Farber's antifolates and made a link between the rapidly dividing leukemia cells in the bone marrow of children and the rapidly dividing placental cells in women. Li reasoned, if the antifolates would stop aggressive leukemias from growing- even if temporarily-might they not at least partially relieve the eruptions of choriocarcinoma? Freirich said Li was 'experimenting' on people because Li's patients had supposedly already been 'cured' of cancer using the specified ( and approved ) dosed of antifolate therapy. At the end of several rounds of chemotherapy , Li expected to see minor changes in the size of his patients tumors. But Li found the tumor masses disappeared, the chest x-ray improved, and the pt. looked normal. The level of choriogonadotropin (hcg), the hormone secreted by the cancer cells, plummeted toward zero but did not reach zero. Li had decided early on that he would use the marker (hcg) as a surrogate for the cancer, its fingerprint in the blood. Li resasoned if the hcg was still present in the blood, then cancer had to be present too, hiding in the body somewhere and therefore the patients had not been 'cured' So Li ignored protocol and the added toxicity of additional rounds of the drug until the hcg level was zero. I do not believe Li's actions were unethical because he was acting in good faith and in the best interest of his patients.Li saw 'signs' of cancer and was determined to rid his patients of it. "Li had stumbled on a deep and fundamental principle of oncology: cancer needed to be systemically treated long after every visible sign of it had vanished. Several years later, Li's strategy resulted in the 1st chemotherapeautic cure of cancer in adults. If Li had followed the 'old rules' and did absolutely nothing, what would doctors, scientists and patients have today? Probably, NOTHING!!!!
ReplyDeleteThis comment has been removed by the author.
ReplyDeletehahahahha!
Delete3. The author writes how in the early 1950's, the New York Times refused to print the word cancer or breast. Compare this to how we view cancer today.
ReplyDeleteIn the early 1950’s cancer research did not have the highest priority. As soon as cancer research looked promising World war II occurred and the hospitals that could have been used for research were being used to treat wounded soldiers that needed medical attention. It did not seem that cancer research was important because time and money could be allocated elsewhere. Also not much was known about cancer and was frowned upon to in the eyes of the meidia. The word cancer was being replaced with disease. Today cancer is viewed as one of the top killers. It is publicized and people make adjustments to their lifestyles to avoid it. Certain products have warning labels on them letting people know the use of some products have been known to cause cancer. All of this media on cancer could be a result of the research breakthroughs that have led us to a better understanding of how it develops and its mechanisms.
4. SIdney Farber's early clinical experiments with antifolates in 1947 and 48 were a failure, with all his young leukemia patients eventually dying fo teh the disease. But with the results of these trials, Mukherjee writes, Farber saw a door open. Why do Farber's trials mark a turning point in the history of cancer research?
Folic acid is a Vitamin B and has been found to be important of cell division. Since previous findings showed that folic acid, when treated with nutrient-deprived patients, could help with normal genesis of blood. The links between vitamins, bone marrow, and normal blood caught Farbers attention. His first clinical trial exploring these connections ended up accelerating the leukemia in children and was a disaster. Even though the trial was a disaster, Farber found the results revealing of new information. This led him to investigate the effects of the chemical antifolate to cut off the supply of nutrients to bone marrow. Chemotherapy had never been used before to treat cancer. The synthesis of folic acid produces intermediate analogs, which mimic folic acid, but act as a competitive inhibitor to folic acid. Farber saw the door open when he used this on leukemia patients and found that the chemical caused white blood cell count to slow down and plateau, but later that door shut when patients relapsed and died. This was a turning point because Farber’s work laid the groundwork for future research and medicine that could be used for future patients.
5. Review the case on Min Chiu Li (135-138) and explain why Freirich said that Li was accused of experimenting on people, but that he also states that everyone was experimenting .. to not experiment would mean to follow the old rules-to do absolutely nothing. Do you think Li's actions were ethical?
Min Chiu Li researched Choriocarcinoma cancer, which leads to tumours in the lung. The mutant Choriocarcinoma cells secrete the hormone choriogonadotropin, which was treating with the drug methotrexate. Since methotrexate drops the levels of choriogonadotropin, monitoring the levels of this hormone help to determine the stage of the cancer. When Li treated his choriocarcinoma patients with methotrexate he found that the hormone level dropped significantly, but never dropped to zero. Even though visible phenotypes of the cancer were gone, Li thought that the cancer was still present in the patient’s blood. Li continued rounds of methotrexate and chemotherapy until the hormone levels had dropped to zero. This is when Freirich had ethical concerns of Li’s work and accused him of experimenting on people. Li’s patients did not relapse, although he was fired for his “experiments”. I do not think Li was being unethical because without his commitment to completely rid signs of cancer, the first chemotherapeautic cure of cancer in adults may not have been discovered.
3. I think there was great promise when Senator Bone stated at the ground breaking for the National Cancer Institute, "the nation is marshaling its forces to conquer cancer..."
ReplyDeleteAnd with this there was now going to be a national response to the cancer problem in the nation. Unfortunately WWII couldn't have come at a worst time, if it had to come at all. The war against cancer was overshadowed and the facilities that were once thought to become the institutes labs and places for research was reconfigured back into a military hospital to aid in the growing number of injured soldiers. Funds were diverted to war efforts, and Scientist, physicians, and advocates of cancer research all "fell off the radar." It was something that couldn't be controlled and eventually would lead to the silencing of cancer as the main topic of interest for the nation.
Today, there is a much different approach to cancer research in general. There is more awareness now of the disease itself, and not just from the scientific standpoint, but also from the public education view as well. It's not all up to the government anymore to fund this research. Funding from the private sector has significantly changed the world in the way of understanding cancer and just how we can fight it. Institutes like American Cancer Society, City of Hope, and a number of other institutes around the country have made it their personal mission to take on cancer, and look for new ways to treat patients diagnosed as well as raise funds to help in the research efforts. You can't go anywhere these days with out seeing a sign or flyer advocating for "finding the cure." Modern media has also made the job easier. It’s nice to know that even with war always looming over our heads these days, that we don't forget about the wars that are being fought at our own hospitals, and it's nice to know that the soldiers who fight it - doctors, scientists, and students - are all getting the support that they need, and no longer being overshadowed or silenced.
4. I can only imagine what it must have been like to feel a sense of triumph for Farber and his colleagues to see results from using his antifolates in their clinical experimentation, and the pure joy that they would get from seeing children they treated return to school, gaining back some "normalcy.” Yet it would all be marred by the relapse of the leukemia that would eventually lead to the death of your patients. I can tell you this, it gets me emotional just recalling these stories as I write this entry. I can't imagine what it must have been like to see that "momentary normalcy" for those children to be stripped away by the cancer relapse. But no matter how small a window was seen, it was a window of opportunity nonetheless. It was a chance at a cure. It was the light at the end of the tunnel. Farber's early clinical trials may have failed, but they didn't go without accomplishment. The patients he lost were sad regardless, yet there was great understanding that came from this, and a new found hope that maybe this isn't a death sentence and there may be a way one day to end the suffering of so many that are ailed from this disease.
5. It's often hard to say what is ethical at times. In retrospect, we can say that Dr Li’s efforts were needed and it was his efforts that lead to the first chemotherapeutic treatment that remised the caner in adults; however, that is only because we see it from the post-experimental viewpoint. I agree with the statement "...to not experiment would mean to follow the old rules-to do absolutely nothing" but it’s also hard to decide what is okay to experiment on. It all comes down to what boundaries are to be pressed, what questions are worth answering, and is a minuscule number worth perusing to see it experimentally reduced to zero? In this case, yes.
ReplyDeleteThis is one of the reasons we find it hard for experimentation and research to be carried from the lab setting to the bedside. How do we treat those suffering when we can't get approval for implementing the results we see in the laboratory setting? What decides the level of risk? Are we only to allow experimental treatments for those that are left with no options, or do we allow those that volunteer to be able to take advantage of a potentially life saving treatment? Researchers and review boards are always fighting these fundamental questions when it comes to human clinical trials, and they should be taken into careful consideration when deciding to go ahead with experimental treatments; however, I agree with Dr Li, we can never stop experimenting, because to do so would be to give up and do "absolutely nothing."
3. I would argue that the way cancer is much more explored and talked about today than it was in the 1950’s. Back then, no one wanted to talk about “inappropriate” topics in the paper, like cancer, which they considered to be as much of an inappropriate word as breast. From Mukherjee’s work, it seems like no one cared or had confidence in finding a cure for cancer. Sidney Farber for example wasn’t being supported in his research with anitfolates very much. Today seems much different in the level of available information and concern about cancer. Especially due to technology, one can find plenty of information online on a variety of websites and hospital sites. There are several walks or support events to fund money for cancer research. Even shirts are sold with the words “Keep a Breast” and “I Love Boobies” to spread breast cancer awareness. The month of October is dedicated to spreading breast cancer awareness. I’m sure that a shirt with the word breast or cancer on it would have been too taboo 60 years ago. Now, doctors and scientists have been paying more attention to the disease and many want to spread awareness to the everyday individual.
ReplyDelete4. Sidney Farber’s work was extraordinary at the time because his anitfolates provided temporary relief in his cancer patients. Obviously, there was something in these drugs that calmed, almost stopped the growth of cancer. Although the cancer in his patients always came back, Farber saw potential in this medicine, possibly a cure. This was a turning point in the history of cancer research because no had come close to producing results the way Farber had. The idea of specificity to target cancer cells would be the next idea in finding an effective treatment for cancer.
5. It’s difficult to say if Li’s actions were ethical or not. What’s interesting was that Farber had done the same thing with his young cancer patients and even accelerated their deaths, and he was not fired. I believe if an incident like that were to take place today, it definitely would not have been acceptable. However, in the 1950’s, the understanding of cancer was not as well defined as it is today. So I believe Li and Farber’s experiments were necessary for the time. I agree with Freireich’s words, when he said to not experiment would be to do nothing. Even though Li lost his job, I think he helped with the bigger picture in the search for a cure. Others after Li can see the effects of his experimenting and generate a better understanding as well as a potential cure.
3. According to the author cancer in the 1950’s was expressed differently than it is now. When the New York Times refuses to print words attributing to cancer and even the word cancer itself it portrays the social concept and understanding of the word. Cancer in the 1950’s was likely ignored and not considered a social norm that occurred although medical evidence was present. And in doing so, New York Times was able to superimpose the subject by choosing words to describe that cancer was relatable to a disease and not affiliated with any one particular gender. Cancer was looked over in the broadest terms to diminish what it truly was for something more passable in society. Those who were afflicted often fought their “disease” in closed quarters, but were ostracized in both the medical and social environments. The word cancer itself was worse than the actual disease and was rarely spoken of unless you were a patient undergoing some kind of clinical trial unaware by the general public. The view of cancer now is public awareness and potential treatment options for the future. And in the sphere of public awareness is the advertising of cancer for patients and those seeking informational knowledge about the subject. Cancer is no longer shunt aside but placed as a pivotal concept for understanding humans and their diseases.
ReplyDelete4.Farber’s early clinical experimentations with patients using anti-folates were both a success and a failure. His experiments were a failure because all of his young leukemia patients eventually passed from the disease that he intended to cure. What Farber did succeed in was his use of anti-folates as a temporary inhibitor of leukemia even in the most aggressive kinds. What Farber concluded was the idea that anti-folate drug was able to mimic and be used as a competitive inhibitor of folic acid which lowered the white blood count allowed for some recovery to occur, which he believed was the open door for the life –threatening disease. Unfortunately the door did not remain open to further study the disease and closed with the end of his patients’ lives.Farber’s anti-folates succumbed to other scientists using their own treatments to try to cure leukemia based on previous knowledge acquired from the experiments.
5. Li treated his patients with choriocarcinoma with a drug called methotrexate and observed that the choriogonadotropin hormone levels had dropped significantly, to a negligible amount, but not to a complete zero. According to Li choriogonadotropin levels had not fallen completely to zero because there is a fingerprint of the cancer present in the blood and hiding in the body somewhere even though the visible tumors were gone. So as a result Li’s patients were not cured of the disease but stable. In order to try to rid the patients of the disease he took further steps that were not done and were considered by most (most noteably, Freirich) accuse Li of experimenting on people. Li performed additional rounds of the drug along with chemotherapy until the hormone levels fell to zero. According to NCI Li was accused of experimenting on people because patients were considered cured once the tumors had vanished and that further chemotherapeutic treatments done by Li were merciless. Li’s experiments demonstrated that cancer in some of his patients never relapsed, but did in others. Freirich also states that Li was not the only one experimenting and that all were scientists looking for cures were also experimenting. And by not experimenting would mean to follow the old rules and do so meant not doing anything to find a cure. Freirich says this because they too were using the same methods of using chemotherapy along with doses of extremely toxic drugs, like Li but that Li acted on his principles using recurrent dosage of toxic drugs with chemotherapy until the hormone levels dropped down to zero. And it is for this reason that Li was fired for doing so. I consider Li’s actions to be unethical in terms of unknown experimentation based on multiple rounds of chemotherapy on patients without known outcome. But on the other hand his intentions for the improvement and perhaps cure of the disease was necessary because if no one had done so the information known now would not exist. And had he not gone through with the experiment another scientist would have wondered and done something similar. There is always a risk but to those who are death bound by cancer something like this might turn the tables from death to life.
ReplyDelete3. In the early 1950’s the use of the word cancer was taboo—there was a lot of shame and fear associated with the word and its corresponding disease. Today, we have lost some of the shame, but the word continues to connote a great deal of fear and uncertainty. It is a common topic of discussion in the realm of scientific research and even in our every day lives. This is likely a result of much of the work that Farber did to bring the awareness of Cancer to the forefront of society as a means of gaining support for it’s research. Our ability to openly discuss and publish information about Cancer has allowed us to move forward in our battle against it.
ReplyDelete4. Up to the point before Farber’s antifolates, the only method of treating cancer had been through surgical excision. Farber’s antifolates were ground breaking in that they demonstrated a potential chemical/medicinal treatment for cancer, which was unheard of then. This led the way to the development of chemotherapy, as we know it today. Farber’s study demonstrated that cancer could in fact be overcome, and fueled the subsequent studies that provided some of the greatest developments in the field of Oncology.
5. The concept of medical ethics in the time of Li’s trials was blurry at best. Today, it is considered unethical to perform any experimental treatment on a patient without their consent. The board of the NCI decided that Li’s adjuvant chemotherapy was unnecessary—as they thought that the women receiving this treatment were already cured. Li believed that only by dropping the hgc hormone level down to 0 would a person truly be cured of this form of cancer. Li’s hypothesis was a valid one and as we know now, his actions helped save the lives of many women. I believe his actions were ethical, at least as far as 1950’s ethics were concerned.
3. In that time, cancer was not understood and they did not have a grasp on how to overcome it. Today, we have found cures for some cancers and we know the specific stages that cancer goes through. Since we have a better understanding of cancer, we are able to openly talk and discuss cancer without fear of it. We are no openly able to talk about cancer because everyone wants to bring awareness of cancer to the forefront and not hide it away.
ReplyDelete4. Farber saw an open door with his experiments with antifolates on cancer because he did see some improvement by using the antifolates but did not see a complete remission. Since he was able to see some kind of improvement with the antifolates he used, he knew there would have to be a drug out there that would give him the results he was looking for.
5. Li was accused of experimenting on people because he prolonged the use of chemotherapy until the level of hormones he was observing dropped to zero. He kept administering the drug even after there were no signs of tumors but only a low level of the hormone of interest. This was considered experimenting on people because from their stand point the cancer had been cured but the drugs were still being administered. In retrospect, Li's experimentation was unethical due to the fact that he did not know what the effect of prolonged use of a chemotherapeutic drug.
3. The author writes how in the early 1950's, the New York Times refused to print the word cancer or breast. Compare this to how we view cancer today.
ReplyDeletea. I do not know personally but I would imagine that people in the 50’s were much more uptight than they are now, although it may be just exact opposite. I believe that the New York Times refused to print out the word cancer because it did not want to make their readers aware of such a disease. They may have thought that ignorance is bliss; the less they know about cancer the better. However, this decision may have hindered knowledge to the general public on how to get diagnosed, even if there were no available cures or treatments for that matter. The word breast on the other hand, is a completely different story. I think that the main reason the decided not to print the word was because, quite honestly, the people were too uptight. Maybe it those two words could not be printed together as too keep the public in the dark. Whatever the reason may be, it shows us how times have changed. Today we can say breast, cancer in the same or separate printing. It is just a matter of getting used to the language. Also I think that the prevalence has also been a major contributor; you cant help but to print out the morbidity rates without printing out the word cancer or breast for that matter→it is just so common.
4. Sidney Farber's early clinical experiments with antifolates in 1947 and 48 were a failure, with all his young leukemia patients eventually dying from the the disease. But with the results of these trials, Mukherjee writes, Farber saw a door open. Why do Farber's trials mark a turning point in the history of cancer research?
a. Farber was the first to use chemicals, antifolates, as a chemotherapeutic agent. He saw that the antifolates prolonged the patient’s life for some time and the health of the individual actually improved. Although some of his patience did get better for some time, they did eventually relapse into the cancer once again. The cancer came back more aggressive than ever, which would eventually lead to the patients demise. Farber believed that the antifolates had the potential to briefly prolong the life of the cancer patient, and maybe other chemical derivatives could do a better job. Moreover, the idea that two chemical is better than one and that three is better than two, and so on, came into play. The drugs would have a synergistic effect, which would increase the likelihood of beating the cancer. Even though his patients died, Ferber’s research was revolutionary because he showed that the cancer disappeared and therefore can be treated.
5. Review the case on Min Chiu Li (135-138) and explain why Freirich said that Li was accused of experimenting on people, but that he also states that everyone was experimenting .. to not experiment would mean to follow the old rules-to do absolutely nothing. Do you think Li's actions were ethical?
a. I will bluntly say that Li’s actions were ethical. At least for me, being ethical is being moral and doing what is morally correct. If taking every measure to save someone’s life is unethical, then I don't really understand the meaning of the word. Li’s actions were and still are justified because he had to do everything in his power to try everything under the sun in order to save the person from relapse of the cancer. He made sure that there were no more traces of the protein even after the tumors had been removed.
There is a very interesting play on words; the word “experimenting” takes you to a dark place, something like Mary Shelley’s Frankenstein where the creature is being created, and maybe that is why many people believe it was unethical for Li to continue treating his patients, even after the tumors had disappeared. Li’s patients, unlike the patients of doctors, never had a relapse of the cancer. To see the look onto the faces of Li’s accusers when they found out that Li’s patients never relapsed and had the right idea. That would be nirvana!
3. We view cancer in a much different light today. I think overall, we embrace it more and want there to be a bigger awareness of the different cancers and diseases that are out there. If they were unwilling to publish the word cancer or the word breast in the 1950’s, they definitely would not have printed that a famous actress had anal cancer, which is what Farah Fawcett was diagnosed with a few years ago. But I also think that having celebrities being diagnosed with cancer, people are more interested to reading about it.
ReplyDelete4. I think Farber’s approach to cancer was different at that time. He was looking for a different approach to treat the disease. Instead of looking at treating the symptoms, he was looking at attacking the disease from a different angle. Unfortunately, he chose the wrong approach and ended up intensifying the disease and a lot of young children had their lives cut short, but that mishap actually made him think outside the box again and attack from a different angle.
5. It’s difficult to say whether his actions are ethical or not. It is not ethical to keep infusing toxic chemicals into someone’s bloodstream just to see what would happen to the hormone levels in the blood. However, with the patients already having been very ill and at death’s door, Li knew that having levels still visible in the blood was still not right, so he went with his intuition and continued chemotherapy. But ethical or not, his risk (and the risks to his patients) actually showed to be very useful because doctors learned that stopping chemotherapy too early, even though the symptoms may be gone, would be detrimental in the future because the cancer could return because not all of it is gone.
3- According to author, in 1950s, NY times refused to print any thing related to cancer, even the word Cancer. That by it self tells us a lot about the point of view on cancer at that time. It seemed more of a social abnormality, just as calling HIV as GRID. But now its very different in a unique sense, mostly because of awareness, and variety of treatment options, or could be due to its inclining in population, its no longer pushed to corner. Its implication are different now, back then it was considered a death sentence, now advances in technology have changed its meaning by lot.
ReplyDelete4- His idea was brilliant, but it has both ends, success and failure, his anti folates, even tough didn't cure his patients, which later reached equilibrium. But anti folates did act as inhibitors, mimic to inhibit folic acid, which might help to raise white blood count, a window to recovery perhaps. Due to his patient early death he wasn't able to find the answer, but his research has huge impact on cancer therapy now, his ideas inspired other researchers to look into alternative mechanism.
5- Li used a drug called methotrexate and observed that the choriogonadotropin hormone levels had dropped to threaten level. According to him his patient still have some hallmark (contaminant) polluting her blood, even no tumor was visible, his contribution to proceed toward the solution lead to experimental accusations, but his method leas to drop of hormone levels to zero. But again all the scientist were performing similar procedures, even Freirich himself, using toxic drugs with chemotherapy, but again it was better than doing nothing. But his methods were unethical because his dosage levels seems random, and depleting hormone level, but his intentions to me were still noble, trying to reach the root of the issue, in this case cancer.
3. During the 1950's cancer research and awareness was still emerging. I can understand the New York Times stance. They did not know enough about the disease to use these those particular terms in the article. The audience may have not known how to fully interpret the article back then. The story is completely different today with the wealth of information available today. Now days readers want and have access to the latest advancements in health care. Any attempt by a publisher to censor information would be meet with backlash from the audience.
ReplyDelete4. The clinical experiments may have been considered a failure due to the expected results on being produced but valuable data was still extracted from the experiment. Faber was able to show folic acids effect on cancer cells and wbc production. Experiments like Faber's arm researchers with more data to form future hypothesis and lead to more effective chemotherapeutic agents.
5.
5. I do not believe that his actions are ethical to my standards. I believe in patient disclosure and consent. I do acknowledge that times things are not as always black and white as I would like them to be. I believe that Dr. Li felt he had no choice but to continue on with his experiments because he could not stomach standing by knowing he had a hypothesis which had the potential to save life. When considering what is ethical it is important to factor in the time period and what was considered to be the social norms. There were other researchers preforming similar experiments so Dr. Li's actions need be examined using that context. So I would say that now days Dr. Li's actions may be considered unethical but for the time they were acceptable.
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ReplyDelete3. Mukherjee alludes to the big taboo of cancer in the 1950s—being described at the time as a “macabre hit parade” (182). However, such fear and misunderstanding of the word led to the New York Times prohibiting the breast cancer survivor, Fanny Rosenow, from placing an ad for a support group for women with breast cancer. The New York Times claimed that neither the words “breast” nor “cancer” were suitable for print—instead to replace the term with “diseases of the chest wall”. Since such times, we have come a long way. By 1970s in conjunction with the sexual revolution, society no longer whispered about “breasts” nor “cancer; we no longer fail to print the words “breast cancer” merely in fear of offense. Especially with our enhanced understanding of the disease, breast cancer is open to public to not only for discussion, but even has support groups. Today’s radicalization has even accepted shirts/accessories with “I <3 BOOBIES” in support of breast cancer. Since the fifties, we have indeed come a long way.
ReplyDelete4. From the initiation of Lucy Willis’ discovery of healthy blood level normalcy of nutrient deprived patients—Farber attempted to test the validity of folic acid as a possible treatment for leukemia patients. When Farber notices the acceleration of leukemia from folic acid—he administers the counter antifolates that may REDUCE leukemia blood cell growth. His first trialed antifolate, pteroylaspartic acid (PAA), yielded minimal effect on his 2 year old patient Robert Sandler. However his second trialed antifolate, aminopterin, “a chemical with a small change from the structure of PAA”, although temporarily, had restored Robert Sandler’s blood normalcy and health for a few months (33). Despite Robert Sandler’s death in 1948, Farber’s clinical trial publication received astounding feedback. For the first time, “cancer, even in its most aggressive form, had been treated with a medicine, a chemical” (36). Hence via his aminopterin experiment, a new door was opened leading to the turning point of cancer research history.
5. Placenta cancer researcher Min Chiu Li attempted to make use of Farber’s antifolate drug aminopterin in his clinical trial with the cancer smitten patients. Although his first test of aminopterin on a lung cancer patient significantly diminished most of the tumors, a hint of cancer—noted by the minuscule amount of tumor secreted hormone choriogonadotropin, still persisted even though the patient seemed to have gained normal health. This persisting cancer levels aroused Li to push with the chemotherapy drug, despite the added drug toxicity to the body, until choriogonadotropin levels reached zero. Even though, this experiment displayed the important aspect of ‘persisting cancer until complete dissipation of choriogonadotropin levels’ –Min Chu Li’s “experimenting on people” cost his career. As Freirich described that “everyone [else] was experimenting”, Min Chu Li’s push yielded in risking the conditions of the patient—an unethical act (137). As Mukherjee implies, Li “seemed almost to be treating a number rather than a patient” (137). By unethically placing his clinical trial patients in danger, I feel Min Chu Li made ends justify the means.
3. In the current media there is a constant bombardment of the words cancer and breast. There is an increased awareness of breast cancer, prostate cancer etc. By talking more about cancer we are increasing its awareness and getting more people involved in checking themselves and taking action to prevent cancer. Without awareness people might not feel comfortable talking about diseases associated with sexual organs or sex (STDs) and this lack of awareness would lead to improper attention of the diseases by the patients.
ReplyDelete4. After trying many different chemicals Farber found a drug where children regained some of their energy, and were playing again. The drug he discovered gave the children some extra time to live and not being exposed further pain. Unfortunately these children were not fully cured, but Farber saw that there might be a possibility that there is a drug out there than can fully reverse the cancer. Even though nobody had ever heard of such a drug, Farber was sure that someday someone would eventually discover these drugs, saving the lives of many people.
5. At that time (and even still today) it was very difficult to even know what kinds of treatments would work against cancer. I believe that Min Chiu Lis actions were ethical in a sense, Ethel Longoria was extremely ill and they had to try something new. By utilizing the antifolates they were able to see an improvement in Longorias cancer, Li had a suspicion that the cancer was still present due to the presence of choriogonadotrophin . Therefore he continued to use the drug in hopes of getting rid of the protein from the blood stream. He was trying something new but with a cause, even though the cancer was not visible he was not confident that the patient was cured. If they would have not tried the antifolates in the first place, the patient would have died sooner if left without any treatment.
3. The author writes how in the early 1950's, the New York Times refused to print the word cancer or breast. Compare this to how we view cancer today.
ReplyDeleteBack in the early 1950's cancer was viewed as a silent, unmentionable disease that was kept more private. It seemed to be an abnormal scenario when someone has breast cancer. Rosenow, a cancer survivor and an advocate of cancer wanted to publish about cancer, however, the publisher refused to mention the word breast or cancer. Back in the 1950's, cancer was recognized as an incurable disease; a disease that was not cured, only observed and since there was no cure, people with the disease just chose to be unaware of the disease.One: the society was a little more upright and conserved also it could be that the I feel it may have been due more than one factor. Before it was just observed and nothing was done to cure it, but now we are working more towards spreading the awareness and curing cancer. In today's world, it seems as if society has accepted cancer and the society now is more aware of cancer and choose to spread the awareness throughout the world.
4. SIdney Farber's early clinical experiments with antifolates in 1947 and 48 were a failure, with all his young leukemia patients eventually dying fo teh the disease. But with the results of these trials, Mukherjee writes, Farber saw a door open. Why do Farber's trials mark a turning point in the history of cancer research?
Farber faced both success and failure: he faced success because he found a temporary cure for leukemia, and it led him to dream that there could such an anticancer drug that would kill the malignant cells and he dreamt of curing leukemia and other more common cancers with chemicals and it started out with his experimentation of anti-folate. It all began when he realized folic acid was required for cell division, and that was his failure as well as a success; after injecting his patients with folic acid, he realized that it speeds up the progression of leukemia. He hastened the death of many children (failure) but that also led him to realize if he had some sort of an anti-folate; he could decelerate the progression. This resulted in the discovery of anti-folates which led to his dream of curing leukemia and other cancers with chemicals.
5. Review the case on Min Chiu Li (135-138) and explain why Freirich said that Li was accused of experimenting on people, but that he also states that everyone was experimenting .. to not experiment would mean to follow the old rules-to do absolutely nothing. Do you think Li's actions were ethical?
I think the definition of ethical has changed overtime, in the 1950's when this was taking place, there were no release papers to sign for families or patients and knowing there was no cure for this disease. Li had been working on choriocarcinoma and it seems he had made a link between the rapidly dividing placental cells in a woman and in the leukemia cells. Either way the patient was bound to die so I feel that, by experimenting on her, he got rid of her disease and brought her back to the level of normality. I feel that he realized that link and worked towards what he believed might be the cure. A cure can't be found with only one experiment and so Li continued experimenting. He was working on making the building blocks of curing the disease so I believe it was necessary to do so. If he didn't experiment, there would be no cure, it would have remained as one of those observed, but untreated diseases.
3. The author writes how in the early 1950's, the New York Times refused to print the word cancer or breast. Compare this to how we view cancer today.
ReplyDeleteIn the 1950's, the book describes that the social outcry about cancer drifted into silence. This disease was considered to be unmentionable and only whispered about. Moreover, when Fanny Rosenow wanted to post a support group for women with breast cancer, the New York Times in fact refused to put the words breast and cancer and offered to put up an announcement about a meeting about diseases of the chest wall. During this time, cancer was still considered to be emerging. We still did not know much about cancer, and since it was seen as almost incurable, perhaps it was better seen to be "kept under wraps" in order to portray the "cookie cutter" American Image that seemed to be displayed back then. However, now we have more awareness of the disease, and if caught on time, can be treated with higher chances of survival. The key to survival rate is informing the public about it, thus it is more seen in society today.
4. SIdney Farber's early clinical experiments with antifolates in 1947 and 48 were a failure, with all his young leukemia patients eventually dying fo teh the disease. But with the results of these trials, Mukherjee writes, Farber saw a door open. Why do Farber's trials mark a turning point in the history of cancer research?
I believe Farber's failure in deed provided success because it showed that when he injected his patients with folic acid, it had the reverse affect of what he had initially expected. Folic acid had originally worked for Lucy Wills, when she was treating anemia patients from Bombay who had an "unknown anemia." Although Folic acid had worked for Wills, and not for Farber, this information was crucial and indicated that Folic acid actually accelerated the death of the patients, thus accelerating the replication of the malignant cells. This in turn enabled him to look at anti-folates to be used as anti-cancerous drugs. Although antifolates didn't work entirely, he saw that it reversed the process and the patients would get better for a short amount of time. This gave him hope that there was a treatment, or cure out there that would cure this disease.
5. Review the case on Min Chiu Li (135-138) and explain why Freirich said that Li was accused of experimenting on people, but that he also states that everyone was experimenting .. to not experiment would mean to follow the old rules-to do absolutely nothing. Do you think Li's actions were ethical?
Freirich's argument that all the doctors were experimenting was true at that time. However, Li decided to push the envelope, so to speak, and subjected patients with further cancer treatment, although the visible signs of cancer had been gone. I think in a way this was unethical. Perhaps he should have consulted with the patients and get their approval. Even if he was right, there was a chance that he could have been wrong and therefore exposed them to more toxicity than was necessary. Nonetheless, he had been right, and sometimes a person needs to stand up for what they know is right, and do things as he did, with the permission of the patients.
3. The author writes how in the early 1950's, the New York Times refused to print the word cancer or breast. Compare this to how we view cancer today.
ReplyDeleteBack in the early 1950s, much was kept from the public. People who had cancer fought their own battles. Now a day, even though we have advanced in the field of cancer research, studies, diagnostics, treatments, and for some cancer types, a cure – I think cancer is still in some ways a private issue. It is still common for people to refer to cancer as the “C” word versus the entire word. However, I think that people refer to cancer as the “C” word out of fear because I am sure we all fear being diagnosed with cancer with the increased cancer types out there…. I think the New York Times refusal to print the word cancer or breast back in the early 1950s was, in a way, ignorance. I feel that regardless of what was known about cancer at that time, the public had a right to a full news review. I don’t think the New York Times had a valid or good reason to refuse to print the word cancer or breast and if they do, I am sure it can easily be challenged. Furthermore I am sure they are not refusing to print the words cancer or breast in today’s newspapers.
4. SIdney Farber's early clinical experiments with antifolates in 1947 and 48 were a failure, with all his young leukemia patients eventually dying fo teh the disease. But with the results of these trials, Mukherjee writes, Farber saw a door open. Why do Farber's trials mark a turning point in the history of cancer research?
Farber’s early clinical experiments marked a turning point in the history of cancer research because it “opened the doors” for other scientists to carry their own experiments for a drug against cancer. Potentially thanks to Farber’s early clinical experiments that were both a success and failure, do we now have the advancement we now have against cancer; Some cancer types being completely treatable and curable while others not so much. I think his clinical experiments with anti-folates in 1947-1948 were a chemotherapeutic agent that brought hope for his young leukemia patients. In a sense it can now be thought of as a chemotherapeutic agent that buys time for leukemia patients, however, at the time it was great splendor to see that the young leukemia patients were slowly regaining normalcy and strength back. Then unfortunately they relapse with greater leukemia signs and symptoms that eventually took their young lives. Nonetheless Farber’s experiments was and still is a major turning point in the history of cancer research because it brings hope and faith that there exist a cure out there for cancers and with time it will be found.
5. Review the case on Min Chiu Li (135-138) and explain why Freirich said that Li was accused of experimenting on people, but that he also states that everyone was experimenting .. to not experiment would mean to follow the old rules-to do absolutely nothing. Do you think Li's actions were ethical?
ReplyDeleteI think Min Chiu Li’s actions were ethical. I think he acted on the knowledge that if there exist trace amounts of the Choriogonadotropin hormone in a patient’s system, then he or she will have the potential of the cancer relapse. Even though the cancer itself had been removed, the trace of the hormone that still lingered in the blood meant that there was still trace cancer that was lingering in the patient’s blood. I think he did what was ethical, possibly giving the patient the option to choose whether they continue treatment until the hormone levels dropped to zero or if they discontinued treatment once the cancer was removed and the hormone level dropped to negligible levels, may be the only change or thing I would have done different had I been in Li’s position. Although, I understand Freirich’s standpoint that Li was “experimenting” on people, but I think that only through experimentation will the truth prevail. Like the saying goes, “Live and Learn”. At the end of the day, I agree with what Li did and I think it was unethical that he lost his job when he truly had his patients’ best interest at heart. … Now that is a doctor that I would want and seek. I think professionals should always seek their patients and/or clients best interest and not their own, don’t you agree?
3. The author writes how in the early 1950's, the New York Times refused to print the word cancer or breast. Compare this to how we view cancer today.
ReplyDeleteIn the 1950s cancer was rarely heard of and not much was done to find cures. During this time there were other diseases that were more fatal and were researched more. Fanny Rosenow idea for support group was rejected by the New York Times because cancer and breast was not appropriate at that time. Now cancer is one of the top main subjects in many articles and newspapers because many people are aware of it and there are many types of cancer. In today’s society there are many different ways to inform the people of the risks of cancer and how to prevent to not getting cancer. People are more open minded and aware of many diseases.
4. SIdney Farber's early clinical experiments with antifolates in 1947 and 48 were a failure, with all his young leukemia patients eventually dying fo teh the disease. But with the results of these trials, Mukherjee writes, Farber saw a door open. Why do Farber's trials mark a turning point in the history of cancer research?
Farber treated his patients with antifolates which helped the children to live longer but still had leukemia. After seeing that his patients were dying even after being treated saw that the cancer cells can be inhibited for a while. This was breakthrough that there can be a type of drug to help cure or control the growth of the cancer. After this was known it gave a turning point for other doctors to use that information and make different drugs with antifolate to help cure leukemia.
5. Review the case on Min Chiu Li (135-138) and explain why Freirich said that Li was accused of experimenting on people, but that he also states that everyone was experimenting .. to not experiment would mean to follow the old rules-to do absolutely nothing. Do you think Li's actions were ethical?
During that time many doctors were experimenting with patients because cancer was not researched as much in labs as it is done now. If something had to be done about finding a cure they had to experiment on their patients. It is hard to determine if it was ethical because with today’s society it would be unethical of experimenting on patients. Li took the risk of experimenting even after the patients have been cured to see what other affects can arise. Li did not want to just sit back and not doing anything.
3. The author writes how in the early 1950's, the New York Times refused to print the word cancer or breast. Compare this to how we view cancer today.
ReplyDeleteI think it has more to do with how the media is run in todays society and the cultural changes from the 50's and on. In the 1950's the United States was still a very conservative country, there were proper ways to do everything and certain topics like cancer were considered inappropriate to talk about, not to mention breast cancer. Now times have changed and the media is always trying to bring up death and disasters to grab the readers attention. So cancer as one of the highest's killers is definitely at the top of the list. Faber's search to find a cure for cancer definitely included getting the word out there about cancer. His Jimmy Campaign really helped to bring cancer to the surface of American life and help people become more aware.
4. SIdney Farber's early clinical experiments with antifolates in 1947 and 48 were a failure, with all his young leukemia patients eventually dying fo teh the disease. But with the results of these trials, Mukherjee writes, Farber saw a door open. Why do Farber's trials mark a turning point in the history of cancer research?
Faber's results marked a turning point in cancer because although his patients eventually failed they first got better; they went into remission. This showed people that cancer can be stopped that there is a way to fight cancer and it can work with chemicals.
5. Review the case on Min Chiu Li (135-138) and explain why Freirich said that Li was accused of experimenting on people, but that he also states that everyone was experimenting .. to not experiment would mean to follow the old rules-to do absolutely nothing. Do you think Li's actions were ethical?
I think they would have been ethical if he would have explained the situation to his patients and then gotten their consent. The drugs Li was using were and are very lethal drugs and very painful process and since he did not have any concrete data to support his hypothesis he was just simply experimenting on people without their knowledge. Patients trust their physicians to understand and give them advice on things they don't understand. I think a doctor should explain any new and novel treatments he is going to be trying out on a patient. Since the evidence showed that the cancer had been coming back in other patients that did not try Li's way I probably would have said yes to him continuing the chemo.